Intravesical OnabotulinumtoxinA Injection for Overactive Orthotopic Ileal Neobladder: Feasibility and Efficacy

Abstract

The efficacy of intravesical onabotulinumtoxinA (BTXA) in the treatment of overactive bladder (OAB) has been well documented. The use of BTXA injection in orthotopic neobladders is yet to be studied. We present 4 cases of patients injected with intravesical BTXA for overactive orthotopic ileal neobladder. We recorded patient demographics, presenting and follow-up symptoms, urodynamic profiles, and Patient Global Impression of Improvement (PGI-I) scores. The 4 patients reported varying degrees of subjective improvements in the symptoms, including urgency, urge incontinence, and pad usage. Mean follow-up duration was 8.3 months (range, 5–14 months). Average PGI-I score was 3 (“a little better”) (range, 2–4). To our knowledge, the current study is the first case series examining BTXA injection for orthotopic neobladder overactivity. BTXA injection yielded varying degrees of objective and subjective improvements, without significant complications. Intravesical BTXA injection is feasible and may be considered as a potential treatment alternative for OAB in orthotopic neobladders, although further study is warranted.

Cluster analysis identifies three urodynamic patterns in patients with orthotopic neobladder reconstruction

“…Previous studies have described the presence of neobladder over-activity and the association with nocturnal incontinence and urge incontinence [ 19 , 20 ]. A recent study has shown the efficacy of intravesical botulinum toxin injection in the treatment of patients with neobladder over-activity and urinary incontinence [ 21 ]. In our urodynamic evaluation, we could not definitively define neobladder over-activity due to various forms of intraluminal pressure change and urodynamic artifact.…”

Efficacy and Adverse Events Associated With Use of OnabotulinumtoxinA for Treatment of Neurogenic Detrusor Overactivity: A Meta-Analysis

“…Moreover, evidence suggests that superior efficacy was obtained after combining injection into the detrusor and bladder trigone compared with intradetrusor injection alone [22]. A recent study carried out by Hoag et al [23] showed that, intravesical onabotulinumtoxinA injection is feasible treatment for overactive bladder in orthotopic neobladders. Further studies are needed to determine whether single detrusor injection or combination with trigone injections increases onabotulinumtoxinA efficacy.…”

Refractory bladder dysfunction: A multi-institutional experience with intravesical botulinum toxin-a injection in adult patients who underwent previous augmentation cystoplasty

“…There are clear data showing significant urodynamic and subjective improvements after administration of BTX-A injections in the neurogenic population with either 200 or 300 units. [12,13] Long-term data show that the mean duration of efficacy of intravesical BTX-A is 6-9 months. [12] Our cohort of patients appeared to have longer efficacy with an average repeat injection time of 10.5 months (range 2-42).…”

“…In addition, there has been a case series reporting the use of BTX-A (100-200 units) in four patients with overactive orthotopic neobladder. [13] The authors utilized a minimal depth of needle penetration into the neobladder mucosa (2-3 mm) to decrease the risk of bowel injury or perforation. In this study, there were no significant adverse events with injection of BTX-A into a bowel segment.…”